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1971 E Beltline Ave Ne Suite 212 Grand Rapids MI 49525-7045 | |
| (800) 600-4096 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 1971 E Beltline Ave Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Timothy Royer (OWNER) |
| Authorized Official Contact | 6167065649 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3790 30th St Sw Grandville MI 49418-1602 Ph: (800) 600-4096 | 1971 E Beltline Ave Ne Suite 212 Grand Rapids MI 49525-7045 Ph: (800) 600-4096 |
| NPI Number | 1114290517 |
|---|---|
| Provider Enumeration Date | 02/15/2012 |
| Last Update Date | 02/15/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114290517 | NPI | - | NPPES |
| 1013294628 | Other | MI | NPI # |
| 0D14689 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 6301009353 (Michigan) | Primary |
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